States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018-24

Area of Science:

• Health Policy
• Substance Use Disorders
• Pharmacology

Background:

• Opioid use disorder (OUD) remains a significant public health crisis in the US.
• Federal policies enacted since 2018 aimed to increase buprenorphine prescribing to address the OUD treatment gap.
• National prescribing trends did not show anticipated increases, necessitating state-level analysis.

Purpose of the Study:

• To examine state-level trends in buprenorphine prescribing from 2018 to 2024.
• To assess the impact of federal policy changes and state Medicaid expansion on buprenorphine prescribing rates.
• To identify factors driving disparities in buprenorphine access across states.

Main Methods:

• Utilized IQVIA data covering all-payer and per-payer prescribing.
• Analyzed prescribing data across all US states for the period 2018-2024.
• Correlated prescribing trends with state Medicaid expansion status and enrollment.

Main Results:

• All-payer buprenorphine prescriptions per 1,000 residents increased by over 60% in ten states and decreased by over 10% in eight states.
• States that expanded Medicaid saw significantly higher increases in prescribing compared to non-expansion states.
• Medicaid prescribing was a primary driver of overall prescribing changes, with wide variations in rates and proportions across states.

Conclusions:

• State-specific factors significantly mediate the impact of federal policies on buprenorphine prescribing.
• Medicaid expansion and sustained enrollment are critical for increasing buprenorphine access and addressing the OUD treatment gap.
• Urgent public health action is needed to maintain Medicaid expansions and ensure access to OUD treatment for the adult population.